STENCILDENT

                       NECROTISING FASCITIS  INTRODUCTION: It is a spreading ,destructive ,invasive infection of skin and soft tissue including deep fascia with relative sparing of muscle Common sites:  Lower extremities Genitalia Groin Lower abdomen  Similar to melaneys gangrene CAUSATIVE ORGANISM : MONOMICROBIAL : Group A BETA hemolytic streptococci Type 2 necrotizing fasciitis  POLYMICROBIAL : Synergistic combination anaerobe +coliform /non-group A streptococci  Type 1 necrotizing fasciitis  No history of injury when it occurs in lower limbs RISK FACTORS FOR TYPE 1 NECROTISING FASCITIS : Diabetic mellitus Malnutrition Obesity Corticosteroid Immune deficiency  CLINICAL FEATURES: Affected area: sudden pain, gross swelling of the limbs part: swollen red, erythematous ,edematous skip lesion of necrosis ,ulceration skin changes : Bronze hue Brawney induration Blebs /crepitus High degree fever ,j...

  AUDITORY TUBE /EUSTACHIAN TUBE Shape: Trumpet Length: 4 cm Connect : middle ear cavity with nasopharynx BONY PART  Length: 12 mm Situation: Petrous temporal Form: posterior and lateral one third RELATION: Superior- Tensor tympani Medial- Carotid canal Lateral- Chorda tympani CARTLAGINOUS PART : Length-25 mm Situation-Sulcus tubae Form: anterior and medial two third RELATION: ANTERIOLATERALLY: Mandibular nerve and its branches POSTEROMEDIALLY : Petrous temporal  ARTERIAL SUPPLY: Ascending pharyngeal ,middle meningeal artery  NERVE SUPPLY: Maxillary nerve Mandibular nerve- cartilaginous part  Pharyngeal -bony part FUNCTION: Communicate middle ear cavity to external : equal air pressure on both side of tympanic membrane Tube usually closed :opens during- swallowing, yawning APPLIED ANATOMY: Infection may pass from throat to middle ear Inflammation of tube ,second attack of common cold, sore throat .

                   AGRANULOCYTOSIS Lack of granulocyte  Absolute neutrophil count (less than 100 per microliter) Rare condition Suppressed immune system CAUSES: May be inherited or genetic Drugs: Anti-thyroid ,Anti-psychotic ,antibiotic Exposure to toxic substance such as ARSENIC ,MERCURY Aplastic anemia SYMPTOM : Sore throat and mouth Fever ,chill Fatigue  Headache Sweating  Swollen gland RISK: If left untreated result in sepsis Male and female both at equal risk Certain drug  DIAGNOSIS: Blood test Neutrophil count less than 100 per microliter of blood Bone marrow biopsy TREATMENT: Change of drug Transfusion of granulocyte 

                        PRESSURE SORE: INTRODUCTION: PRESSURE SORE IS ALSO KNOWN AS:  BED SORE/DECUBITUS ULCER   Trophic ulcer with underlying bone as base Non -mobile ,deep ,punched out ulcer Common in : Old age Tetanus Diabetic  Comatose patient Anemia Emaciated patient BED RIDDEN INDIVIDUAL  SITES: Occiput Heel  Sacrum Scapula Elbow Buttock PREDISPOSING FACTOR: Malnutrition Anemia Excessive sweating Edema Incontinence-skin moist, septic Friction due to foreign body, bed sheet  Superficial bed sore 75%common  Deep bed sore is painless and covered with slough TREATMENT: Change of position in bed Use of water bed ,ripple bed Bed-smooth, free from wrinkles Skin-dry, clean, washed with soap Ripple bed-alternate pressure point pad under bottom sheet of ordinary mattress Urinary incontinence- specialized silicone bed clothes Good nursing ,regular dressing  Good nutrition is necessary Antibiot...

                      INTERNAL JUGULAR VEIN  Direct continuation of sigmoid sinus Extent: From jugular foramen -end clavicle along with subclavian ends at brachiocephalic vein ORGIN: Superior bulb in jugular fossa of temporal bone TERMINATION: Inferior bulb in supraclavicular fossa RELATION: SUPERFICIAL: Sternocleidomastoid Posterior belly of digastric Superior belly of omohyoid POSTERIOR: Atlas Cervical plexus MEDIAL: Internal carotid Common carotid Vagus TRIBUTARIES: Lingual vein Pharyngeal vein  Superior thyroid Middle thyroid Thoracic duct open into union of left internal and left subclavian -right duct In middle of neck internal jugular communicate with external jugular  APPLIED ANTOMY: Deep to supraclavicular fossa internal jugular can be easily accessible for recording venous pressure During cardiac failure :venous pressure increases internal jugular gets inflated  

                                     CYTOKINES  INTRODUCTION: Cells communicate at molecular level by cytokine Paracrine function: released peptide and other molecule Soluble protein SECRETD BY : Hemopoietic  Non-hemopoietic cells in response to various stimuli ROLE: Activaton of immune system  PROPERTIES EXHIBITED: PLEIOTROPHIC: One cytokine act on different cell type REDUNDANCY: Similar function by different cytokine Cascade induction: one cytokine stimulate its target cell to make another cytokine SYNERGY: Combination cytokine result in combined effect  CATEGORIES: INTERFERON-involved in antiviral response  INTERLEUKIN-produced by one leucocyte, act on other TUMOUR NECROSIS FACTOR TRANSFORMING GROWTH FACTOR COLONY STIMULATING FACTOR-support growth of blood cell GROWTH FACTOR Growth factor and other cytokine -CRINOPECTIN Cytokine involved in leukocyte endothelial cel...

                          TRACHEOSTOMY INTRODUCTION: Tracheostomy is making an opening in anterior wall of trachea and covering it into stoma on skin surface Types:  Emergency tracheostomy, Elective tracheostomy Permanent tracheostomy Mid tracheostomy ideal, commonly used through 2nd and 3rd rings behind isthmus Tracheostomy tubes are made of plastic ,soft ,least irritant and disposable  They have inflatable cuff, should be deflated at regular interval to prevent -tracheal necrosis due to pressure FUNCTIONS: Respiration through alternative pathway in case of obstruction above the stoma Protection of airway from: aspiration of pharyngeal secretion in comatose patient  Blood due to injuries in pharynx ,larynx INDICATION: RESPIRATORY OBSTRUCTION: Infection- Ludwig angina, Peritonsillar infection Tumor Trauma to larynx, trachea RETAINED SECRETION: (Inability to cough) Comatose patient Painful cough -trauma to ch...